Improving Child Nutrition

An Investment in the Future

Undernutrition is the single largest killer of children globally. It is responsible for 2.6 million child deaths each year.1 Virtually all these deaths are preventable. For millions more children, the consequences of undernutrition are lifelong and irreversible. Today, 165 million children are chronically malnourished (stunted), which can cause serious and irreversible physical and mental disabilities. The failure to address undernutrition is one of the underlying reasons for the slow progress on many of the Millennium Development Goals and why many will not be met by 2015. Therefore, it is essential that this year 2013 decision makers prioritise an increase in investment in nutrition. The June Hunger Summit, hosted by David C am e ro n , p ro vid es th e opportunity to bring new energy to this neglected area and secure a healthy and prosperous future for millions of women, children and families.

RESULTS UK. Credit Steve Lewis

THERE ARE HUGE LONG TERM COSTS OF NEGLECTING UNDERNUTRITION

The human costs are enormous, with the consequences falling hardest on the very poor, and on women and children. One-third of all child deaths stem from undernutrition. Globally 165 million (26%) of children under the age of five are chronically malnourished (stunted) and another 55 million (10%) are acutely malnourished (wasted). Undernutrition also weakens the immune system, increasing susceptibility to infections and illness, and magnifies the impact of diseases such as HIV/Aids and Tuberculosis (TB). Whats more, individuals who have HIV or TB are also at significantly higher risk of undernutrition because of increased calorie needs and reduced earning capacity. The economic costs are also high. Those who experience poor nutrition in the first 1000 days of life (from conception to 2 years) have a higher risk of lifelong physical and mental disabilities, which is likely to impact their cognitive ability, school performance and earning potential. Stunted children have been shown to enroll in school at a later age and complete fewer years of school. When they reach adulthood they are often not able to make a full contribution to the social and economic development of their households or communities. The economic cost of undernutrition, in terms of lost national productivity and economic growth, are enormous. Countries can lose between 2 to 3 percent of their potential Gross Domestic Product (GDP) each year.2
INVESTMENTS NOW BUILD LONG-TERM ECONOMIC GROWTH

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There are huge short-term and long-term benefits to prioritising nutrition now. Investing in nutrition can lead to enhanced economic growth through: Job creation. Children who are not undernourished do better in school, and in adult life, earn 20% more in the labour market and are 10% more likely to own their own businesses.3 Increased productivity, due to a healthier workforce and lack of stunting, as well as improvements in micronutrient status.

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Saving of resources currently directed to healthcare, disease treatment and other problems associated with undernutrition.4 For example, it is estimated that preventing micronutrient deficiencies in China and India would save the two countries US$5 and $2.5 billion per year, respectively.5 Acceleration of fertility declines, which is driven by a decline in infant mortality and more effective family planning. Stunted children are twice as likely to die as non-stunted children.6

WE KNOW WHAT TO DO

Nutritional status is affected by three factors: food, health and care. Effective interventions to combat undernutrition are well known, but they need to be scaled up if they are to have a significant impact. In 2008 the Lancet identified 13 effective nutrition specific interventions, addressing the immediate causes of undernutrition, which would yield significant results if delivered to scale. These specific interventions promote practices to improve nutrition (e.g. increased rates of exclusive breastfeeding and timely introduction of adequate complementary foods), reduce deficiencies in essential micronutrients (e.g. vitamin A supplements), and prevent and treat moderately malnourished and acutely malnourished children (e.g. supplementary and therapeutics foods). Together they could reduce stunting by one-third globally and child mortality rates by onequarter. There is a growing evidence base that, in addition to nutrition specific intervention, nutrition sensitive interventions are an essential component for addressing undernutrition. These address the underlying causes of undernutrition, which are embedded in the household and community level context. Nutrition sensitive interventions include improving food security, the status of women, childcare practices and access to water, sanitation and health services.
INVESTING IN NUTRITION IS GREAT VALUE FOR MONEY

ENDNOTES
1. UNICEF, 2011, Levels and Trends in Child Mortality: Report 2011. bit.ly/ZDzybJ [last accessed 18 April 2013]. 2. World Bank, Nutrition: Overview. http://uni.cf/ qb63KK [last accessed 18 April 2013]. 3. IDS, 2013, Delivering Demographic Dividend in Africa: Investing in Nutrition is the First Step. 4. DFID, 2009, The neglected crisis of undernutrition: Evidence for action. 5. Shekar and Lee, 2006, Mainstreaming nutrition in poverty reduction strategy papers: what does it take?, A review of early evidence. HPN discussion paper, Health Nutrition and Population, World Bank . 6. IDS, 2013, Delivering Demographic Dividend in Africa: Investing in Nutrition is the First Step. 7. The Lancet, 2008, What works? Interventions for maternal and child undernutrition and survival. 8. DFID, 2011, Scaling-Up Nutrition: Unlocking Puzzles to Transform Thinking and Action. 9. Based on the costing of five interventionsVitamin A supplementation , therapeutic zinc, micronutrient powders, deworming, and adequate iron and folic acid for pregnant women. Data provided by the World Bank: http://go.worldbank.org/ TVP0EL5YV0.

Investing in nutrition is tremendous value for money and offers excellent returns on investment. The 2012 Copenhagen Consensus found that nutrition specific interventions deliver some of the best value for money of all development interventions: Nutrition specific interventions could reduce stunting by one-third globally and child mortality by one-quarter at a benefit to cost ratio of 16 to 1. 7 Vitamin A and zinc supplementation and salt iodization have been ranked among the top five best development buys.8 A package of five proven life-saving interventions can be delivered for 5 per year per child.9 The human returns are also high, with the potential to prevent 1 million child deaths, 30 million fewer stunted children under the age of five years, and halving the prevalence of severely wasted children.
LEADERSHIP FROM THE UK IS CRUCIAL

Nutrition is rising up the political agenda. This year represents a key opportunity for an increase in nutrition financing, to see interventions delivered to scale, and for the numerous benefits to be realised. Leadership has been shown by African and Asian countries united in the SUN Movement (Scaling Up Nutrition). Several countries have such as Tanzania and Brazil have shown that committed political and financial investment in these interventions can lead to significant reeducations in undernutrition over relatively short time periods. Now large donors and institutions need to support these countries own ambitious plans. The UK, exerting global leadership on nutrition, can galvanise other key donor countries to put finances and political capital to nutrition in three ways: The UK has increased its aid budget. It is the only G8 country to have reached the 0.7% target for international aid. The UK should back up high-level political leadership with significant financial commitments and should call for other countries and institutions to do the same. The June 8th Hunger Summit is an opportunity to showcase UK commitment to nutrition and also to encourage both donors and developing countries to transform the nutrition agenda. It is important that the summit is attended by high-level decision makers ready to make new commitments. David Cameron is co-chair of the high-level panel working on a post-2015 development framework. The UK must ensure that progress on nutrition is a key part of the next set of development goals.

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